Ohio Northern University's HealthWise Mobile Outreach Program

Description

Located in Ada, Ohio, the Ohio Northern University (ONU) is a private college affiliated with the United Methodist Church. One of the university's missions is to focus on the health and well-being of citizens in rural and underserved areas.

In 2013, nearby Hardin County's needs assessment highlighted healthcare access as a major influence on health and wellness. Both transportation issues and limited numbers of care providers were viewed by ONU's College of Pharmacy's as problems that could be impacted with outreach efforts.

Outreach preparation included engagement with county residents to further understand medical and health needs. Relationships with multiple Hardin County clinical partners were easily developed because of shared mission. Called HealthWise, the program began in 2015.

The current program functions as a simple extension of each collaborating organization. Transportation and workforce shortage issues are addressed by bringing student healthcare professionals and their professors to Hardin County communities on a scheduled basis. The effort is centered in clinical services provided by students working as members of an inter-professional team of pharmacists in addition to a laboratory specialist. Disease management, medication reviews, immunizations, and preventive health education services are provided. When possible and necessary, patients are referred to primary medical care.

Visits are scheduled at community gathering locations, such as churches and schools. In August 2017, a partnership with CVS Health and Mercy Health in Lima, Ohio took the outreach effort to a new level with provision of a mobile motor coach.

ONU HealthWise partners also include the Kenton-Hardin Health Department, Hardin Memorial Hospital, Kenton Community Health Center, and Health Partners of Western Ohio.

The outreach program was funded in part by a Federal Office of Rural Health Policy (FORHP) Rural Health Care Services Outreach Grant.

Services offered

The mobile team is comprised of two pharmacy residents and three pharmacists and offers the following services:

No cost/low cost screening services for:

• Blood pressure
• Body Mass Index (BMI)
• Cancer skin exams
• Cholesterol
• Glucose
• Hemoglobin A1C
• Hepatitis C
• Immunizations

Additionally, preventive health education and health risk reduction information is provided for:

• Asthma
• Behavioral Health
• Cancer screening (breast, cervical and colorectal)
• Chronic Obstructive Pulmonary Disease (COPD)
• Diabetes
• Exercise
• Hyperlipidemia
• Hypertension
• Nutrition
• Tobacco Cessation

Patient results are immediately shared following point-of-care testing. Education is delivered and a paper copy of results, pharmacist notes, and recommendations are provided to patients. Patients are advised to take these results to their primary care physician.

The ONU HealthWise team also faxes notes to the primary care provider's office or speaks directly with providers via telephone when necessary. Interventions are documented in paper charts taken to clinic sites and stored in a protected system for outcome tracking. Current collaboration with local hospitals includes plans to implement an integrated electronic medical record system for record keeping/tracking purposes.

Results

From initial implementation in 2015 to 2017, nearly 36 Advanced Pharmacy Practice Experiences (APPE) students per year completed ambulatory care rotations with HealthWise.

The program has increased its number of learners:

• Advanced Pharmacy Practice Experience (APPE) students: 18 per year
• Introductory Pharmacy Practice Experience (IPPE) students: 40 per year
• PGY1 Pharmacy Practice Residents: 2 per year

September 2015 through November 2017 results paired with results as of July 2019:

• 801 patients served with initial program implementation, and cumulative total of 2,059 as of July 2019
• 576 initial screenings, now totaling 1,315
• 514 initial appointments, now increased to 744
• 361 referrals, up from 123 initial referrals

In addition to serving patients, impact on APPE student education is strong. The College of Pharmacy administration notes that this is the most important work it does: delivering healthcare to a rural, underserved community and giving their student pharmacists a personal, first-hand experience practicing in that setting.

Challenges

Marketing

Replication

Essential to a program build is pre-planning with needs assessment review and contacting potential clinical partners. Community feedback should be sought not just during the planning stages, but routinely after project launch since needs may not be intuitive to the service providers.

Be patient with time interval to establish clinical relationships. These are usually not immediate, but when established will positively impact provider and patient and be demonstrated by positive appointment show-rates.

With regards to marketing, be prepared to try multiple approaches. Though slow to build the patient base, word-of-mouth was an effective marketing tool for this program. Another approach was attending community scheduled events. For example, attending free monthly community dinners or meeting community members at the local food pantry to do blood pressure screenings raised community awareness of the HealthWise program. Social media had little impact on this project since many potential patients had no access to this type of messaging.

The project's pharmacist position was initially supported by grant funding.

Contact Information

Michael J. Rush, PharmD, BCACP, CDE, NCTTP, Director of ONU HealthWise & Pharmacy Residency Programs and Assistant Clinical Professor of Pharmacy Practice
Ohio Northern University
419.772.3933
m-rush@onu.edu